SEATTLE--China made substantial gains in health over the past two decades, including increases in life expectancy, reductions in child mortality, and declines in infectious diseases such as tuberculosis and lower respiratory infections. But with that success accompanies the growth of non-communicable diseases and risk factors such as tobacco use and high blood pressure, which could overwhelm the health system.

These are some of the findings published June 8 in The Lancet in an analysis by the Chinese Center for Disease Control and Prevention, Peking Union Medical College and the Institute for Health Metrics and Evaluation (IHME).

The data are drawn from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), a collaborative project of researchers worldwide led by IHME at the University of Washington. The paper compares China to countries in the G20, underscoring the fast-moving pace of health change in China and how it now looks more like the US, UK, or Australia in some respects. China's rate of premature mortality in 2010, for example, was only slightly higher than in the US and lower than all emerging economies in the G20 when accounting for changes in population age.

Looking back to 1990, China had a health profile very similar to much of the developing world, including countries such as Vietnam or Iraq. The leading causes of health loss in China in 1990 were chronic pulmonary obstructive disease (COPD), lower respiratory infections, stroke, congenital anomalies, and neonatal encephalopathy. By 2010, though, the picture had changed in important ways. The main causes of health loss were stroke, ischemic heart disease, COPD, low back pain, and road injury.

Although Chinese women have one of the lowest rates of smoking prevalence in the world, men in China have one of the highest at 52% and exposure to second-hand smoke is as high as 72%.

"Tobacco is one of the top three risk factors in China and deaths attributable to its use have increased by almost 30% since 1990. Aggressive tobacco control measures will be an important public health effort," said Dr. Gonghuan Yang, professor at Peking Union Medical College and a joint lead author of the China GBD paper.

In addition to tobacco use, dietary risks and high blood pressure were the other leading risk factors in China in 2010, followed by ambient air pollution and household air pollution. As the proportion of disease attributable to diet and other individual behaviors increases, non-communicable disease has increased as well.

"Urbanization and aging are two of the driving forces behind the rise of non-communicable disease. The number of deaths from NCDs has grown, along with the rates of diabetes, lung cancer, and ischemic heart disease," said Dr. Yu Wang, director of the Chinese Center for Disease Control and Prevention and a joint lead author of the China GBD paper.

Among non-communicable diseases, cancer puts China in a relatively unique position with respect to the high-income countries studied. In 2010, Chinese women had lower rates of premature mortality from breast cancer than all but two of these countries--including the US, UK, and Japan.

But China has five cancers--lung, liver, stomach, esophageal, and colorectal--in the top 15 causes of premature mortality.

Non-communicable diseases are becoming an increasingly important issue in China at the same time as communicable, maternal, and neonatal disorders have declined by 59% and child mortality by almost 80%, down from 1 million child deaths in 1990 to 213,000 in 2010. Deaths from diarrhea and lower respiratory infections in children under 5 declined by more than 90% since 1990.

"Between 1990 and 2010, life expectancy at birth in China increased from 69.3 years to 75.7 years. Behind this improvement is one of most successful stories in reducing child mortality. Over the same period, child mortality rate has been declining at about 6% annually and this improvement has even been sped up in the most recent decade." said Haidong Wang, assistant professor of global health at IHME and one of the authors of the China paper.

China also fares better on certain conditions with a significant impact on young adults in particular, such as drug use disorders and suicide. Globally, there's been a 38% increase in drug use disorders among people aged 20 to 24 between 1990 and 2010 but that figure has declined by 5% in China. With respect to suicide, there's been a steep decline in rates for young women, 75%, and young men, 49%. The disease burden of self-harm dropped only 7% for young women globally in 2010 and it increased for young men in this age group by 18%.

"China has had remarkable accomplishments in reducing deaths and disability from certain communicable diseases. China's success in these areas shows what's possible for other developing countries," said IHME Director Dr. Christopher Murray. "Annual assessments of disease burden will allow China to track its progress against other countries and set priorities appropriately."

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research center at the University of Washington that provides rigorous and comparable measurement of the world's most important health problems and evaluates the strategies used to address them. IHME makes this information freely available so that policymakers have the evidence they need to make informed decisions about how to allocate resources to best improve population health.

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